1/9. Tarsal navicular stress fracture in a young athlete: case report with clinical, radiologic, and pathophysiologic correlations.BACKGROUND: Tarsal navicular fractures are uncommon but important causes of foot pain. Being alert to this condition can help prevent a delay in the diagnosis. methods: A literature search of medline was undertaken, and a case report of an adolescent with tarsal navicular stress fracture is described. RESULTS AND CONCLUSIONS: Tarsal navicular fractures are often misdiagnosed for months. Because plain radiographs are unreliable, the diagnosis of tarsal navicular fractures requires the use of bone scan, fine-cut computed tomographic scans, or magnetic resonance imaging. Treatment requires strict non-weight-bearing activities to avoid complications. When the alert primary care physician can diagnose this condition, treatment of tarsal navicular fractures can be effective and rewarding.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Bipartite patella fracture.Bipartite patella fracture is an uncommon injury that has rarely been described in the literature. It can be quite debilitating in the competitive athlete and is often overlooked by the treating physician. A bone scan can be helpful in confirming the diagnosis, and appropriate treatment often results in a successful outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Stress fractures of the tarsal navicular.Tarsal navicular stress fractures present a difficult diagnostic and treatment dilemma for the orthopedic physician of an active individual. patients often complain of diffuse, poorly-defined symptoms and have a paucity of physical findings. Initial diagnostic evaluation often. fails to recognize navicular stress fractures which results in delayed diagnosis and treatment. A bone scan is sensitive in detecting this entity and the clinician should use this examination in any patient who is suspected of having a navicular stress fracture. After a navicular stress fracture is confirmed, a CT scan is required to identify the extent of the fracture. The progression of navicular stress fractures is fairly predictable; treatment can be tailored based on the needs of the individual as well as the stage of presentation. Nonsurgical and surgical options are effective treatments for this disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Differential diagnosis of a femoral neck/head stress fracture.STUDY DESIGN: Resident's case problem. BACKGROUND: Identifying stress fractures of the hip can be a challenging differential diagnosis. pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. DIAGNOSIS: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. DISCUSSION: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
5/9. Diagnosis of medial knee pain: atypical stress fracture about the knee joint.STUDY DESIGN: Resident's case problem. BACKGROUND: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. DIAGNOSIS: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. DISCUSSION: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Two consecutive rib stress fractures in a female competitive swimmer.We present a case of two consecutive stress fractures in a female swimmer. The diagnosis of the present stress fracture of the ninth rib was based on clinical history and examination and on a new fracture line and callus formation seen in consequent conventional radiographs. Based on the clinical history and radiography, the patient had suffered another rib stress fracture in the fifth rib 15 months earlier. No external trauma had preceded either of the fractures, and no secondary cause of stress fracture was found. Her anatomical and biomechanical characteristics and training errors seem to have been responsible for the stress fractures. sports physicians should be aware of rib stress fractures. With prompt diagnosis the rest period is short.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Stress fracture of the femoral neck in a long distance runner: biomechanical aspects.With the rising public interest in physical fitness, emergency physicians are seeing an increasing number of stress fractures. early diagnosis, followed by conservative management, allowed a long-distance runner with a compression type stress fracture of the femoral neck to return to running. The biomechanical cause of this injury may be related to erosion of the sole of the running shoe that reduced its shock absorption and increased the potential for injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. methotrexate osteopathy in long-term, low-dose methotrexate treatment for psoriasis and rheumatoid arthritis.BACKGROUND: In dermatology and rheumatology, methotrexate is frequently prescribed in low dosages per week; in oncology, high dosages per week are prescribed. methotrexate osteopathy was first reported in children with leukemia treated with high doses of methotrexate. In animal studies, low doses of methotrexate proved to have an adverse effect on bone metabolism, especially on osteoblast activity. OBSERVATIONS: methotrexate osteopathy is a relatively unknown complication of low-dose methotrexate treatment. We describe three patients treated with low-dose oral methotrexate in whom signs and symptoms were present that were similar to those found in children treated with high doses of methotrexate. All three patients had a triad of severe pain localized in the distal tibiae, osteoporosis, and compression fractures of the distal tibia, which could be identified with radiographs, technetium Tc 99m scanning, and magnetic resonance imaging. CONCLUSIONS: methotrexate osteopathy can occur in patients treated with low doses of methotrexate, even over a short period of time. As pain is localized in the distal tibia, it is easily misdiagnosed as psoriatic arthritis of the ankle, but the diagnosis can be correctly made by careful investigation and use of imaging techniques. The only therapy is withdrawal of methotrexate. It is important that more physicians become aware of this side effect of methotrexate therapy, which can occur along with arthritic symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Sacral stress fractures in athletes.Low back and buttock pain in runners can be a source of frustration for the athlete and a diagnostic dilemma for the physician. The authors reported on 3 cases of sacral stress fractures in women athletes, all of which initially presented as low back and/or buttock pain. Sacral stress fractures have been increasingly recognized as a potential cause of these symptoms, especially in young athletes. Because plain radiograph findings are typically normal, the diagnosis is best made with bone scintigraphy. Computed tomography is indicated if there is concern about neoplasm and to evaluate healing of the fracture. If treated with rest, most of these fractures heal and the athlete can return to previous sports activity. The treating physician should be suspicious of this injury among running athletes reporting sacral and buttock pain that does not respond to treatment.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |